Erickson Velasco is a Rapid Response Nurse working for Toronto Central CCAC.

What I do: I go to see people in their homes if they have just been discharged from hospital and are considered at high risk of returning to hospital.  These people often have chronic conditions (for instance, heart disease, chronic obstructive pulmonary disease, and diabetes) and have been in hospital a number of times in the last year. My goal as a Rapid Response Nurse is to help keep these people from being readmitted to the hospital within 30 days.

A typical day for me: Every day I visit several new clients and follow up with others by phone or in person. With a new client, I come to their home, usually arriving 24-48 hours after they’ve left hospital. I review the hospital’s discharge plan, outlining what the individual should be doing to stay healthy and out of hospital. I educate people about their medical conditions, answer a lot of questions and reinforce what they need to do in order to stay as healthy as possible. People absorb information better when you explain it in their home, and use examples from what you see around them.

Another really important part of the job is doing a medication reconciliation – looking at the medications my client has – there can be a lot – and making sure my client understands how to take them properly. We know that medication errors are one of the main reasons people are readmitted to hospital. It’s common for me to find old bottles of pills that need to be thrown out or find that people haven’t even had their prescriptions filled – hospital prescriptions don’t look like many people expect!

I also contact my client’s primary care provider (usually a family doctor), confirm that my client is under their care, and help set up a follow up appointment for my client. I really try and set up everything I can to help stop the need for going back to hospital.

The best part of my job: I really enjoy coming into someone’s home and educating them to become an active participant in their own care. And I appreciate being able to provide client-centred care. I find out what my client’s priorities and needs are and tailor a plan to meet them. I might find that the reason my client hasn’t filled his prescription is that he can’t afford to – he has to choose between paying for food or medications. When I help him find a solution to this very real challenge, I know I’m making a real difference in his life. This is incredibly satisfying.

The big picture: Rapid Response Nurses can be found all over Ontario. We’re registered nurses who work for Community Care Access Centres and we make sure that transitions from hospital to home work better for the people who need it most.